Version June 2024
| Finding | Differential diagnosis |
| Perineal area (boys or girls) | |
| Perineal inflammation or erythema | Candidal infection, pinworms, perianal cellulitis, contact dermatitis, atopic dermatitis, psoriasis |
| Perineal ulcer or vesicular rash* | Syphilis, herpes simplex virus, varicella, chanchroid, Behçet syndrome, bullous pemphigoid, Epstein-Barr virus |
| Perineal bruising | Mongolian spots, trauma, hemolytic uremic syndrome, Henoch-Schonlein purpura |
| Perianal area (boys or girls) | |
| Perianal erythema | Encopresis, poor hygiene, pinworms, Group A streptococcal or staphylococcal infection, irritants, trauma |
| Anal fissures | Constipation; perianal irritation |
| Perianal scar | May be caused by medical conditions, such as fissures, or lesions of Crohn disease, or from previous medical procedures |
| Venous congestion or pooling | Usually due to positioning of child; may be seen in constipation |
| Flattened anal folds | May be caused by relaxation of the anal sphincter or swelling of the perianal tissues from infection or trauma |
| Anogenital warts¶ | Human papillomavirus, molluscum contagiousum, common warts, skin tags |
| Rectal bleeding | Hemorrhoids, Crohn disease, rectal prolapse, rectal tumors; anal trauma or penetration |
| Anal dilation to less than 2 cm, with or without stool present | May be a normal reflex or caused by severe constipation or encopresis, sedation, anesthesia, neuromuscular conditions |
| Male genitalia | |
| Penile trauma | Hair tourniquet, zipper entrapment injury, straddle injury (history is usually readily available for zipper entrapment and straddle injuries; straddle injuries usually affect the anterior structures) |
| Penile or scrotal erythema | Irritants, infection, trauma |
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